A Common Experience: MSW Interns and the Fear of Treating Trauma
by Fiona Mulvena, MSW
While earning my MSW degree, I’ve observed that one of the most anxiety-producing experiences for MSW students is being assigned clients with extensive trauma histories. If you are an MSW student and have experienced anxiety related to treating trauma, please know that you’re not alone! I deeply struggled with fear around this and, through talking with classmates, discovered these anxieties were incredibly common among us. Some specific fears that we seemed to share included: saying the wrong thing, or not knowing what to say at all; engaging in a way that would retraumatize the client; and general feelings of unpreparedness for effectively supporting someone in their healing.
As I prepare to graduate from my MSW program in just a few short weeks, I would like to share what has helped me address my own anxieties around treating trauma in hopes of helping other students do the same. I also hope that MSW programs will consider my perspective and reflect on any room for improvement in how they are supporting their students in providing trauma-related services at their internship sites.
Talk About It
Fearfulness about treating trauma is a normal experience, especially if you’re just getting started in your profession. Please remind yourself that, in your MSW program, you are in the role of learner, not expert. If we lose sight of this, we may start to place unrealistic professional expectations on ourselves. This is a dangerous place to be, as it can lead to feelings of shame around what we may start to view as professional inadequacies. As we know, shame thrives in isolation and can harm us in numerous ways. If you notice yourself feeling anxious, fearful, or ashamed regarding your internship performance, I urge you to talk it out with trusted peers, professors, and/or field instructors. From my experience, you will quickly find that you’re not alone in what you’re feeling. Just that simple realization can be deeply comforting.
It’s important that you not only feel supported by your program in what you’re experiencing internally related to your internship, but that you also feel supported in a more direct and practical sense. One space where all of these things can and should be addressed is in supervision with your field instructor. It’s crucial that your internship offers you consistent weekly supervision and that your field instructor creates a safe space for effective guidance and collaboration. It’s also important that you come to supervision with a level of preparedness that will make this time as meaningful as possible. I found it helpful to keep a running list of issues that came up for me during the week. Each day, I would reflect on and record challenges I experienced. I would also rate the level of importance and urgency of each item. This practice kept my supervision focused, productive, and purposeful. It also seemed to improve my self-awareness – a necessary skill for identifying and addressing personal anxieties.
Although quality supervision is a critical component of a supported internship experience, it’s not the only place you can seek guidance. I encourage you to openly discuss challenges with your field liaison and professors, as well, committing to seeking support from various sources when you’re not sure how to proceed with treatment. We are new learners in a complex professional field, so it is absolutely expected that we’re going to require consultation and supervision on our cases. It may be uncomfortable at first, but it’s important to practice vulnerability and admit when we’re feeling lost in our work. That is exactly what our liaisons and professors are there for, and I have always found that practicing this vulnerability and seeking support decreases my anxiety and improves my performance.
Start Building Your Toolbox
Hopefully, your MSW program will provide you with education around trauma and clinical skills related to trauma treatment early on in the program. However, this may not always be the case. If you’re finding that you haven’t been offered much information on treating trauma in the classroom, yet you’ve started working with clients with trauma histories in your internship, you may want to get proactive on building your clinical toolbox. The amount of information that exists on treating trauma may seem endless, but I did notice there were a few basics I learned in my Trauma and Loss class that boosted my confidence moving forward.
First, knowing Fallot and Harris’s five guiding principles of trauma-informed care is extremely helpful. These principles include safety, trustworthiness, choice, collaboration, and empowerment, all of which are described in detail in their article Creating Cultures of Trauma-Informed Care (CCTIC): A Self-Assessment and Planning Protocol. As green professionals, we may not yet know many (or any) trauma-specific interventions, but if we engage with our clients in a way that honors these principles, we can be confident that we are doing our best to provide services in an ethical and responsible manner.
Another addition to my clinical toolbox that provided me with a sense of confidence and relief was learning about the phases of trauma treatment. Once I was informed of these phases, I didn’t feel quite so lost - it honestly felt as if someone had handed me a roadmap on how to approach treatment with my clients who had trauma histories. I highly recommend reading the article Understanding Complex Trauma, Complex Reactions, and Treatment Approaches by Christine Courtois, who does a fantastic job explaining the four primary stages of trauma treatment. These stages are: the pre-treatment assessment stage, when important client information is gathered; the early stage, which includes establishing safety, psychoeducation, stabilization, coping skills, and building the therapeutic alliance; the middle stage, in which actual processing of the trauma and resolution occur; and the late stage, where work on identity, self-esteem, and interpersonal relationships will take place. Reading this piece gave me a sense of clarity on how to proceed with my clients, which instantly decreased my anxiety.
Courtois’s article was one of many that helped me navigate my way through treating trauma and managing my fears around this practice during my MSW program. As I mentioned, depending on when and what trauma-related materials are formally offered to you in the classroom, you may want to take some of this learning into your own hands. If you decide that is the right thing for you, I hope you will advocate to incorporate this learning into your internship hours as “research” and/or as discussion topics in supervision with your field instructor. You’re a student and you have a lot on your shoulders right now! If you feel as if you need to do extra readings to support yourself in your internship role, you have every right to advocate for dedicating some of your internship hours to do so.
A Message to Schools of Social Work
Again, my hope for this article is not only to provide students with some tips for managing anxiety around treating trauma, but to also offer information from a student perspective that will help MSW programs support their students as best as possible during their educational careers. The reality is that, no matter what area of social work a student’s placement is in, they will be providing services to clients who have experienced trauma. For this reason, I believe it’s important that all students have a thorough introduction to trauma in the first semester of their MSW program. As hesitant as I am to put any more work on students than already exists, I believe it could be extremely beneficial to assign The Body Keeps the Score by Bessel Van Der Kolk as a summer reading prior to the start of the MSW program. Perhaps once the program has begun, an appropriate portion of time in the practicum classes could be devoted to discussing the content of this book. This is one suggestion out of many possible ways to make sure your students have some sense of preparedness for the services they will be expected to provide at their internships. Whether or not this is the right choice for your school, I hope you will take a look at your program, its course content, and its course sequencing to consider whether or not it is built to best support students in serving clients with trauma histories.
For my final remarks regarding my experience with treating trauma as an MSW student, I would like to acknowledge the fact that I have been gifted an incredible sense of fulfillment from this work. Did I have to address overwhelming anxieties along the way? Yes. Has it been one of my deepest honors to take this journey with the clients I’ve served? Also yes. To the students reading this article, please know that you can do this. Please also know that, right now, it’s 100% okay if you’re not sure how. Talk it out, ask for help, and remember that this is a time meant for learning.
Fiona Mulvena is a recent graduate of California State University, Chico's MSW program. She is currently seeking ASW licensure and aspires to continue engaging in clinical social work, specifically in the field of addiction treatment.